Correlates of lifetime and past one-year HIV-testing experience among men who have sex with men in Japan.

This study aimed to examine correlates of lifetime and past-year HIV testing among men who have sex with men (MSM) in Japan. A unique, anonymous online self-report survey was conducted in 2015. A total of 776 participants completed the survey and answered questions on sociodemographic information, HIV-testing experience, history of syphilis, experience talking about HIV, recognition of AIDS-related community-based organization (CBO) materials, and sex behaviors. HIV-testing experience and related factors were assessed for two groups: regional cities and Tokyo and Osaka. A Poisson regression analysis revealed that higher lifetime HIV testing was associated with older age, previous syphilis diagnosis, and experience talking about HIV. Moreover, higher HIV testing in the past year was associated with experience talking about HIV with friends and recognition of HIV-related CBO materials. Increased dissemination of HIV-related information provided by CBOs may, therefore, be an effective prevention policy intervention targeted at Japanese MSM to promote regular testing and maintain their interest in HIV issues.

Everywhere in Japan: an international approach to working with commercial gay businesses in HIV prevention.

In the UK and Japan, there is concern regarding rising rates of annual new HIV infections among Men who have Sex with Men (MSM). Whilst in the UK and Europe, gay businesses are increasingly recognized as being important settings through which to deliver HIV prevention and health promotion interventions to target vulnerable populations; in Japan such settings-based approaches are relatively underdeveloped. This article draws on qualitative data from a recently completed study conducted to explore whether it is feasible, acceptable and desirable to build on the recent European Everywhere project for adaptation and implementation in Japan. A series of expert workshops were conducted in Tokyo, Nagoya and Osaka with intersectoral representatives from Japanese and UK non-governmental organizations (NGOs), gay businesses, universities and gay communities (n = 46). Further discussion groups and meetings were held with NGO members and researchers from the Japanese Ministry of Health, Labour and Welfare's Research Group on HIV Prevention Policy, Programme Implementation and Evaluation among MSM (n = 34). The results showed that it is desirable, feasible and acceptable to adapt and implement a Japanese version of Everywhere. Such a practical, policy-relevant, settings-based HIV prevention framework for gay businesses may help to facilitate the necessary scale up of prevention responses among MSM in Japan. Given the high degree of sexual mobility between countries in Asia, there is considerable potential for the Everywhere Project (or its Japanese variant) to be expanded and adapted to other countries within the Asia-Pacific region.

[A quantitative analysis of information-seeking behaviors regarding medical institutions with Spanish language support among South American Spanish-speaking migrants in Aichi Prefecture, Japan].

OBJECTIVES: This study aimed to explore the factors associated with information-seeking behaviors regarding medical institutions with Spanish language support among South American Spanish-speaking migrants living in Aichi Prefecture, Japan. METHODS: The survey targeted South American Spanish-speaking migrants aged 18 years and older currently residing in Aichi Prefecture who had lived in Japan for at least three months and who had previously seen a doctor in Japan. The questionnaire was written in Spanish and the survey was conducted from April to July, 2010. Wilson's information behavior model was used to study information-seeking behavior regarding medical institutions with Spanish language support among 245 respondents who completed the questionnaires (response rate: 58.9%). Experience seeking medical institutions with Spanish language support in the Tokai area was set as the dependent variable and a chi-square test was conducted to examine relationships with language support needs, recognition of and access to medical institutions with Spanish language support, living situation in Japan, and Japanese language skills. RESULTS: Among the 245 respondents, 106 were male (43.3%) and 139 were female (56.7%). The average age was 39.6±11.2 years old and 84.5% were Peruvian. The average length of residency in Japan was 11.0±5.7 years, and 34.3% of respondents had lived in Aichi for 5-9 years. A total of 165 respondents (67.3%) had searched for medical institutions with Spanish language support, while 80 (32.7%) had not. Information-seeking behavior regarding medical institutions with Spanish language support was associated with having previously experienced a need for Spanish language support when seeing doctors in Japan, finding and attending medical institutions with Spanish language support in the Tokai area, length of residency in Japan, Japanese language skills, and the language used in daily life. CONCLUSION: Experience in requiring Spanish support when sick or injured in Japan motivated respondents to seek medical institutions with Spanish language support. Communication difficulties in Japanese, speaking Spanish in daily life, and length of residency in Japan were relevant factors in their information-seeking behaviors. Respondents were likely to obtain information from family, friends, co-workers, and Spanish media, but not from public institutions that distribute Spanish material. Finding an effective way to disseminate health-related information was a fundamental health issue for South American Spanish-speaking migrants.

Seroprevalence of Kaposi's sarcoma-associated herpesvirus among men who have sex with men in Japan.

Kaposi's sarcoma-associated herpesvirus (KSHV), the etiologic agent of Kaposi's sarcoma, causes malignancies frequently in patients with acquired immunodeficiency syndrome. In the United States and Europe, KSHV infection is common among men who have sex with men. However, the seroprevalence of KSHV among men who have sex with men in Japan is unknown. In the present study, the seroprevalence of KSHV was investigated among 230 men who have sex with men and 400 age- and area of residence-matched men (controls) using a mixed-antigen (KSHV-encoded K8.1, open reading frame 59, 65, and 73 proteins) enzyme-linked immunosorbent assay and an immunofluorescence assay. Among the Japanese men who have sex with men, serological assays revealed that 27 (11.7%) were seropositive for KSHV; 20 (5%) of the men in the control group were also KSHV seropositive. The seroprevalence of KSHV among men who have sex with men was significantly higher than in the control group (odds ratio = 2.52, 95% confidence intervals = 1.38-4.62, P = 0.0019, Chi-square test). Infection with the human immunodeficiency virus, Treponema pallidum, or hepatitis B and C virus did not correlate with KSHV infection. Furthermore, the association of KSHV seropositivity with specific sexual activities was not statistically significant. In conclusion, a higher KSHV seroprevalence was found among Japanese men who have sex with men than among the controls, suggesting that the circulation of KSHV infection is more efficient among men who have sex with men in Japan than among men who do not engage in such sexual activities.

[Factors associated with HIV testing behavior and intention among men who have sex with men (MSM) in Japan].

OBJECTIVES: This study aimed to explore the factors associated with HIV testing behavior and intention among men who have sex with men (MSM) in Japan. METHODS: A self-administered survey was distributed to gay bar customers in Tokyo, Kanagawa, Osaka, Aichi, Fukuoka, and Okinawa from 2010 to early 2011. A total of 4,572 completed surveys were received by mail. Participants were divided into 3 groups based on HIV testing experience and intention: Group 1 consisted of those who had tested at least once in their lives; Group 2 consisted of those who had never tested but had an intention to test; and Group 3 was made up of those who had never tested and had no intention to test. Associations between groups were assessed using Chi-square goodness-of-fit test and multiple logistic regression. RESULTS: Among the 2,809 respondents reporting anal sex within the previous six months, 131 HIV-positive cases were excluded. Data were thus analyzed from 2,678 MSM; 61% (n=1,633) of participants reported having taken an HIV test at least once in their lives, 20.2% (n=541) reported never having tested but with an intention to test, and 18.8% (n=504) reported never having tested and had no intention to test in the future. Knowledge about HIV and testing, STI history, sexuality, academic background, knowing someone with HIV, and condom use in the past six months all correlated with HIV testing experience when compared between groups 1 and 2. Conversations on HIV/AIDS with friends, lifetime STI history, knowing someone with HIV, conversations on HIV/AIDS with a sexual partner, and older age were all correlated with intention of taking an HIV test when compared between groups 2 and 3. CONCLUSION: Among gay bar customers, those who know someone living with HIV and those who had conversations with friends about HIV/AIDS in the previous six months were more likely to take an HIV test compared to those who had never tested but had an intention to test. Thus, although knowledge about HIV and testing is important, knowing someone with HIV and having conversations about HIV/AIDS with friends are also important. Such factors should be considered in promoting the uptake of voluntary HIV testing among MSM.

[Clinical evaluation of intraoperative cardiac output measurement by a new arterial pressure waveform analysis method( FloTrac/Vigileo) in open heart surgery].

We retrospectively evaluated the initial clinical experience of intraoperative cardiac output measurement by a new arterial pressure-based cardiac output (APCO:FloTrac/Vigileo) analysis in patients undergoing open heart surgery. Thirty-two patients (mean age 76.4, range 59 to 90)who underwent cardiac surgery under cardiopulmonary bypass( CPB) from July 2008 to September 2009 in our institute were enrolled in this study. There were 14 women and 18 men. The cardiac operations included 28 valve surgeries and 4 coronary artery bypass grafting. The APCO was introduced initially, then a continuous cardiac output (CCO:Swan-Ganz catheter) analysis system was established following the induction of anesthesia. The correlation of both cardiac output measurements was evaluated at 5 time points, T1:induction of anesthesia, T2:sternotomy, T3:after weaning from CPB, T4:closure of the chest, and T5:arrival at intensive care unit. There were no serious complications related to APCO and CCO. The correlation between APCO and CCO was evaluated by Bland-Altman plot analysis. The percentages of correlation between both groups were T1:81.2%, T2:78.1%, T3:59.4%, T4:62.5%, and T5:65.6%. A good correlation was shown in all 6 patients with atrial fibrillation at T1 and T2. No correlation was shown in the 3 patients with left ventricular( LV) dysfunction below LVEF 40%, 1 case at T3, all 3 cases at T4, and 2 cases at T5. Before the institution of CPB, 3 of the 6 at T1 and 3 of the 7 at T2 in whom no correlation was shown, had severe aortic valve insufficiency (AVI).From these results, APCO appears to be an acceptable device to evaluate the intraoperative cardiac output measurement compared with CCO, except in patients with LV dysfunction or AVI at some time points. Further studies will be necessary to elucidate the precise clinical evidence to assess the efficacy of this new analysis device.

[Open heart surgery in a patient with a history of Takotsubo cardiomyopathy].

An 81-year-old man had a history of Takotsubo cardiomyopathy induced by general fatigue after travel and acute gastritis 2 years previously. Recently, dyspnea on effort had been worsening. Since preoperative echocardiography showed severe aortic valve regurgitation (AR) with left ventricular (LV) dilatation, aortic valve replacement (AVR) by the standard procedure was indicated. Since the safety of the perioperative clinical course including recurrence of Takotsubo syndrome and hemodynamic compromise was unclear, a thorough examination was performed before surgical intervention. AVR with a 21 mm Mosaic bioprosthesis was performed. Transesophageal echocardiography (TEE) during operation did not demonstrate any sign of Takotsubo syndrome and good LV function was maintained. The patient was discharged on postoperative day 18 without any cardiac events including arrhythmia or clinical symptoms such as chest pain. Based on these results, open heart surgery under cardiopulmonary bypass (CPB) and cardiac arrest could be safely performed in patients with a history of Takotsubo cardiomyopathy with minimum use of cardiac agents including cathecholamine and sufficient perioperative removal of emotional and physical stress.

[Condom use staging and correlations among gay and bisexual men. A questionnaire survey of Osaka gay bar customers].

OBJECTIVES: This study aimed to clarify stages of condom use among gay and bisexual men at gay bars in Osaka and to assess relationships between condom use stage and attitudes and norms regarding HIV prevention. METHODS: In this cross-sectional study, a self-administered survey was distributed to gay bar customers in Osaka in 2005. Completed surveys were received through the mail. Participants were divided into five groups based on condom use with regular and casual partners: pre-contemplation; contemplation; preparation; action; and maintenance. These five groups were merged into three groups: precontemplation; contemplation/preparation; and action/maintenance. Associations between these three groups of condom use stage and correlates were assessed. RESULTS: Among the 601 respondents (response rate, 44.9%), data from 546 men with lifetime sexual experience with men were used. Regarding stage distribution, the highest percentage of participants was in the pre-contemplation stage with a regular partner, and in the maintenance stage with casual partners. Activities of "MASH Osaka", a gay non-governmental organization, were widely recognized across all stages. The feeling of being unable to tell a partner to use a condom if the partner resisted condom use, being in a long-term relationship, difficulty using condoms when under the influence of drugs or alcohol, and self-efficacy all correlated with condom use stages. CONCLUSION: This study clarified condom use stages and correlations among gay and bisexual men at gay bars in Osaka. More research is needed to assess the reliability and validity of these scale items. Monitoring stage distributions and correlations with stages will be useful to evaluate HIV prevention activities.

HIV Testing by Public Health Centers and Municipalities and New HIV Cases During the COVID-19 Pandemic in Japan.

BACKGROUND: During the COVID-19 outbreak, facility capacity for HIV testing has been limited. Furthermore, people may have opted against HIV testing during this period to avoid COVID-19 exposure. We investigated the influence of the COVID-19 pandemic on HIV testing and the number of reported HIV cases in Japan. METHODS: We analyzed quarterly HIV/AIDS-related data from 2015 to the second quarter of 2020 using an anomaly detection approach. The data included the number of consultations, the number of HIV tests performed by public health centers or municipalities, and the number of newly reported HIV cases with and without an AIDS diagnosis. We further performed the same analysis for 2 subgroups: men who have sex with men (MSM) and non-Japanese persons. RESULTS: The number of HIV tests (9,584 vs. 35,908 in the year-before period) and consultations (11,689 vs. 32,565) performed by public health centers significantly declined in the second quarter of 2020, whereas the proportion of new HIV cases with an AIDS diagnosis (36.2% vs. 26.4%) significantly increased after removing the trend and seasonality effects. HIV cases without an AIDS diagnosis decreased (166 vs. 217), but the reduction was not significant. We confirmed similar trends for the men who have sex with men and non-Japanese subgroups. CONCLUSIONS: During the COVID-19 pandemic, the current HIV testing system in Japan seems to have missed more cases of HIV before developing AIDS. Continuously monitoring the situation and securing sufficient test resources by use of self-testing is essential to understand the clear epidemiological picture of HIV incidence during the COVID-19 pandemic.

Potential for sexual transmission of HIV infection from male injecting-drug users who have sex with men in Tehran, Iran.

BACKGROUND: Iran faced an HIV epidemic among injecting-drug users (IDUs) and has responded to this threat. Meanwhile, there is growing concern over the possibility of bridging HIV infection from IDUs to other populations, including men who have sex with men (MSM). METHODS: Cross-sectional biobehavioral surveys were conducted among 370 injecting-drug users recruited from drug treatment centers, a drop-in center, as well as streets in drug-populated areas in Tehran, Iran, between 2003 and 2004. RESULTS: Data from these surveys showed that about 12% of male, sexually experienced IDUs have had same-gender sex, and HIV prevalence is high (19%), but condom use during the last sexual encounter was low (20%). A multivariate analysis showed that IDUs who had sex with men (MSM IDUs), compared to other sexually experienced IDUs, are younger (AOR, 0.89; 95% CI, 0.81-0.98), more likely to have used a shared needle/syringe for drug injection (AOR, 4.29; 95% CI, 1.82-10.12), and have had more than 5 sexual partners in their lifetime (AOR, 2.71; 95% CI, 1.14-6.44). CONCLUSIONS: These results show that MSM IDUs exhibit more drug-related and sexual risk behaviors that may serve as a bridge for sexual transmission of HIV to other populations, including the broader MSM community, in Tehran. This report intends to encourage health authorities in Iran to take serious action to prevent sexual transmission of HIV from MSM IDUs to their sexual networks.

[Simultaneous operation of off-pump coronary artery bypass grafting and Y-grafting through median laparotomy incision; report of a case].

A 57-year-old man with both coronary artery disease and iliofemoral occlusive lesions was successfully operated with a combined revascularization procedure. Through a median laparotomy incision, off-pump coronary artery bypass grafting (OPCAB) using the right gastroepiploic artery and aorto-bifemoral bypass were performed simultaneously. The patient recovered well and experienced neither angina nor intermittent claudication.

[The HIV/AIDS epidemic among MSM and gay NGO activities in Japan].

The increase of the number of reports of the person with HIV and the patient with AIDS continues focusing on the Japanese MSM in 1996 and afterwards. Gay community centers have been set up to provide information about HIV/STI for gay community in Tokyo, Osaka Nagoya, and Fukuoka. The percentage of respondents undertaking HIV tests in the previous year was increasing. From now, it is important to support the activities of gay NGOs.

Prevalence and incidence of HIV-1 infection in a community-based men who have sex with men (MSM) cohort in Ulaanbaatar, Mongolia.

The number of HIV-1-infected men who have sex with men (MSM) Mongolian patients started to increase steeply just before 2011. We started collaborative work with community-based organizations that promote safer sex and HIV testing for MSM since mid-2010. Since early 2013, the Mongolian Government has implemented the treat-all strategy for MSM. To determine the efficacy of these countermeasures, we established an MSM cohort in the capital of Mongolia, Ulaanbaatar, in December 2013. HIV antibody was examined at every visit by rapid test. Syphilis was also examined to monitor their sexual behavior. Clients positive for either rapid test were referred to the National Center for Communicable Diseases, Ulaanbaatar, to confirm the results and treatment. Since safer sex promotion is one of the purposes of this cohort, HIV-positive clients were also eligible to participate. A total of 849 MSM were registered and 2,409 HIV/syphilis tests were conducted until December 2017. During this period, 499 (58.8%) clients visited the testing sites repeatedly. Among the 849 clients, HIV-1 infection was confirmed in 83 at registration (prevalence of HIV- 1: 9.8%). One HIV-1 seroconverter was identified (from negative to positive), resulting in incidence of HIV-1 of 0.10/100 person-years (PY). Syphilis was positive in 144 cases at registration (syphilis prevalence: 17.0%), and 53 new syphilis infection cases were diagnosed during the same period, with an incidence of 5.66/100 PY. Despite the high prevalence of HIV-1, the incidence was very low. The results suggest that countermeasures for HIV-1 prevention seem effective in this cohort, however, we still need further strategies for syphilis control.

Seasonal Variations in the Achievement of Guideline Targets for HbA1c, Blood Pressure, and Cholesterol Among Patients With Type 2 Diabetes: A Nationwide Population-Based Study (ABC Study: JDDM49).

OBJECTIVE: Precise monthly achievement rates for reaching guideline targets for HbA1c, blood pressure (BP), and lipid levels remain unknown. We evaluated achievement rates on a monthly basis in persons with type 2 diabetes mellitus (T2DM) and explored related factors. RESEARCH DESIGN AND METHODS: This retrospective study initially analyzed data on 104,601 persons with T2DM throughout Japan. Patients whose HbA1c, BP, and LDL cholesterol were measured ≥12 times during a 24-month period were included. We evaluated monthly achievement rates. Achieved targets were defined as HbA1c <7%, BP <130/80 mmHg, and LDL cholesterol <100 mg/dL. Achievement of all targets was expressed as the "all ABC achievement." RESULTS: A total of 4,678 patients were analyzed. The achievement rates of all ABC, HbA1c, BP, and LDL cholesterol were lowest in winter, with those for systolic BP (SBP) being particularly low (all ABC, summer 15.6%, winter 9.6%; HbA1c, 53.1%, 48.9%; SBP, 56.6%, 40.9%; LDL cholesterol, 50.8%, 47.2%). In winter, age ≥65 years (odds ratio 0.47 [95% CI 0.34-0.63]) was independently related to decreased achievement rates for SBP, BMI ≥25 kg/m2 (BMI 25-30 kg/m2, 0.45 [0.29-0.70]; BMI ≥30 kg/m2, 0.35 [0.22-0.57]), and diabetes duration ≥10 years (0.53 [0.37-0.76]) were independently related to lower achievement rates for HbA1c. Insulin use and sulfonylurea use were independently associated with the decreased all ABC achievement rates in both summer and winter. CONCLUSIONS: The all ABC achievement rate for guideline targets changed on a monthly basis. Seasonal variations in the all ABC achievement rate should be considered when managing T2DM in ordinary clinical practices.

Substance use and sexual behaviours of Japanese men who have sex with men: a nationwide internet survey conducted in Japan.

BACKGROUND: Japanese men who have sex with men (MSM), especially those living in large metropolitan areas such as Tokyo and Osaka, are facing a growing HIV/AIDS epidemic. Although the Internet is used as a new venue for meeting sex partners, it can also serve as a useful research tool for investigating the risk behaviours of Japanese MSM. This Internet survey explored the extent of substance use and its association with sexual risk behaviours among Japanese MSM. METHODS: Between 28 February 2003 and 16 May 2003 MSM were recruited through 57 Japanese gay-oriented Web sites, gay magazines, and Internet mailing lists. Participants completed a structured questionnaire anonymously through the Internet. RESULTS: In total, 2,062 Japanese MSM completed the questionnaire. The average age of participants was 29.0 years and 70.5% identified as gay, 20.8% as bisexual, and 8.7% as other. Overall, 34.5% reported never using a substance, 45% reported ever using one type of substance (lifetime reported single substance users), and 19.6% had used more than 1 type of substance (lifetime reported multiple substance users) in their lifetimes. The substances most commonly used were amyl nitrite (63.2%), 5-methoxy-N, N-diisopropyltryptamine (5MEO-DIPT) (9.3%), and marijuana (5.7%). In the multivariate analysis, unprotected anal intercourse, having had 6 or more sexual partners, visiting a sex club/gay venue in the previous 6 months, a lower education level, and being 30 to 39 years of age were associated with both lifetime single and lifetime multiple substance use. Lifetime reported multiple substance use was also correlated with having a casual sex partner, having symptoms of depression, being diagnosed as HIV-positive, and greater HIV/AIDS-related knowledge. CONCLUSION: This is the first Internet-based research focused on the sexual and substance use behaviours of MSM in Asia. Our findings suggest a compelling need for prevention interventions to reduce HIV risk-related substance use behaviours among Japanese MSM. The results also suggest that the Internet is potentially a useful tool for collecting behavioural data and promoting prevention interventions among this population.

The intent and practice of condom use among HIV-positive men who have sex with men in Japan.

To evaluate the intent and practice of condom use among Japanese HIV-positive men who have sex with men (MSM), a survey using anonymous questionnaires was carried out and 117 respondents were investigated. For anal sex and oral sex, respectively, 58.1% and 15.2% intended to use condoms and 47.2% and 12.4% used condoms all of the time. The intent of condom use decisively affected the practice of condom use and was closely related to the perceived risk level of HIV/sexually transmitted (STI) transmission. In anal sex, willingness to protect sexual partners from HIV infection was strongly related not only to the intent but also to the practice. Enhancement of willingness to protect oneself from STI was suggested to enhance willingness to protect his/her sexual partners from HIV infection with secondary enhancement of the intent or the practice of condom use. Specific support of MSM with HIV for improving the intent and practice of condom use is urgently needed.

Prevalence of and factors associated with HIV-1 infection among drug users visiting treatment centers in Tehran, Iran.

OBJECTIVES: This study was conducted to identify the prevalence of and potential risk factors for HIV-1 infection among drug users visiting drug treatment centers in Tehran, Iran. DESIGN: Cross-sectional quantitative study. METHODS: Between October 2003 and May 2004, drug users who visited three public drug treatment centers in Tehran were interviewed and information about their sociodemographics, drug use characteristics, incarceration history, sexual history, and HIV/AIDS knowledge and risk perception were collected. Specimens of oral mucosal transudate were then collected from participants to be tested for HIV-1 antibodies. Logistic regression analysis was conducted on the association between the demographic and behavioral factors with HIV-1 infection. RESULTS: Overall, 611 (588 male and 23 female) drug users participated in the study. Among male injectors with HIV-1 prevalence of 15.2%, a history of shared injection inside prison [adjusted odds ratio (OR), 12.37; 95% confidence interval (CI), 2.94-51.97] was the main factor associated with HIV-1 infection. Among those who reported no history of injecting drug use, HIV-1 prevalence was 5.4%, and lack of condom use during sex was significantly associated with the infection (adjusted OR, 3.42; 95% CI, 1.25-9.36). CONCLUSIONS: HIV-1 infection is already prevalent among drug users in Tehran, Iran and shared injection inside prison has been revealed to be a particular risk factor for HIV-1 infection among injecting drug users. Harm reduction programs which have been started in Iran should be urgently expanded particularly in correctional settings and strengthened by condom use promotion to prevent sexual acquisition or transmission of HIV-1 among drug users.

Long-term results after Starr-Edwards mitral valve replacement in children aged 5 years or younger.

BACKGROUND: Mitral valve replacement with prosthetic valves in infants and children requires consideration of multiple variables. When we examined our late follow-up, the effect of the growth of the patient relative to the size of the prosthesis placed was the most important variable predicting late successful results. We reviewed our experience with mitral valve replacement using the Starr-Edwards ball valve in children aged 5 years or younger, focusing on the effect of valve prosthesis-patient mismatch on the long-term results in the growing patient. METHODS: From August 1974 to June 1986, 8 patients aged 5 years or younger underwent mitral valve replacements using the Starr-Edwards prosthesis size OM in 3 patients and 1M in 5 patients. Model 6320 was used in 1 patient and Model 6120 in the remaining 7 patients. RESULTS: Follow-up was 100% from 15 to 27 years (mean, 20 years). No valve-related complications of thromboembolism, anticoagulant-related hemorrhage, or prosthetic valve endocarditis were seen. All patients normally developed to adult size. The range of the valve area index of the 3 patients who received the smaller Starr-Edwards valve (size OM) was 0.97 to 1.24 cm2/m2. Although this size valve was adequate for patient growth to adolescence, in each case valve replacement with a larger valve was required. CONCLUSIONS: Our long-term review of Starr-Edwards ball valve mitral valve replacement in children aged 5 years or younger shows that the Starr-Edwards ball valve (Models 6320 [1 patient] and 6120 [7 patients]) showed excellent durability, no thromboembolism, and no anticoagulant-related complications. Size OM valves required replacement for hemodynamic reasons because of patient growth; larger size 1M valves remained hemodynamically satisfactory in spite of patient growth.

[Anti-rubella virus IgG in urine: epidemiological application of a new enzyme-liked-immunosorbent assay (ELISA)].

OBJECTIVES: To evaluate the utility of urinary assessment for epidemiological studies of rubella, we measured anti-rubella virus immunoglobulin G (anti-RV IgG) using samples from pediatric patients with initial rubella infection, healthy volunteers who received a prophylactic inoculation of live rubella vaccine, and 3 years-old children undergoing a health examination at a community health center. METHODS: Blood and urine samples were collected from 12 of spontaneous rubella cases treated at 7 local pediatric clinics during acute and convalescent stages. In addition, blood and urine samples were collected from 17 healthy volunteers receiving prophylactic rubella vaccination immediately before, and 3 and 6-7 weeks after vaccination. Urine samples for anti-RV IgG measurement were also collected from 740 children 3 years of age at Odawara Community Health Center after obtaining informed consent from their parents. In addition, a questionnaire survey of the past history of prophylactic vaccinations was conducted. Serum titers of anti-RV antibody were measured using VIDAS Rubella-IgG and IgM (bioMerieux Japan Ltd.) and urinary titers of anti-RV IgG by ELISA (Otsuka Pharmaceutical Co., Ltd.). RESULTS: 1) The sensitivity and specificity for anti-RV IgG measurement in urine were 99.4% and 100%, respectively. 2) Six of 12 cases suspected of rubella infection were confirmed as initial rubella infection, and showed significantly increased anti-RV IgG titers in convalescent sera. Anti-RV IgG titers were also increased in the urine specimens. 3) In 17 subjects who received prophylactic inoculation with live rubella vaccine, serum titers of anti-RV IgG were increased 6-7 weeks after vaccination and anti-RV IgG was also detected in urine samples from all cases. 4) Urine samples from 80.9% of the children were positive for anti-RV IgG. In addition, 81.7% of the 698 cases, whose parents completed the questionnaire had received prophylactic inoculation with live rubella vaccine, confirmed by the vaccination records in maternal and child health handbooks. Furthermore, urine samples from 12.5% of children who had not received prophylactic live rubella vaccination were positive for anti-RV IgG. CONCLUSIONS: The results of this study suggest that increased antibody titers after spontaneous rubella infection and prophylactic vaccination can be confirmed by measuring antibody titers in the urine. The results also suggest that urine sampling is useful for epidemiological studies of rubella because collection is simple, even from children.